PATENT APPLICATION FEE DETERMINATION RECORD
Effective October 1 , 2001
Application or Docket Number
CLAIMS AS FILED - PART I
TOTAL CLAIMS
*3
r
FOR
NUMBER FILED
NUMBER EXTRA
TOTAL CHARGEABLE CLAIMS
J) minus 20=
*
INDEPENDENT CLAIMS
J) minus 3 =
*
MULTIPLE DEPENDENT CLAIM PRESENT
□
* If the difference in column 1 is less than zero, enter "0" in column 2
CLAIMS AS AMENDED - PART II
(Column 1)
(Column 2) (Column 3)
<
z
LLI
CLAIMS I
REMAINING
AFTER I
AMENDMENT
HIGHEST
NUMBER
PREVIOUSLY
PAID FOR
PRESENT
EXTRA
s
o
z
Total
*
Minus
**
UJ
5
Independent
*
Minus
=
<
FIRST PRESENTATION OF MULTIPLE DEPENDENT CLAIM
n
(Column 1)
(Column 2)
(Column 3)
ENTB |
CLAIMS
REMAINING
AFTER
AMENDMENT
HIGHEST
NUMBER
PREVIOUSLY
PAID FOR
PRESENT
EXTRA
2
Q
Z
Total
*
Minus
**
ID
5
Independent
*
Minus
<
FIRST PRESENTATION OF MULTIPLE DEPENDENT CLAIM
u
(Column 1)
(Column 2)
(Column 3)
ENTC 1
I CLAIMS
\ REMAINING
AFTER
AMENDMENT
1 HIGHEST
j NUMBER
PREVIOUSLY
1 PAID FOR
PRESENT
EXTRA
5
Q
Z
Total
★
Minus
★*
UJ
5
Independent
*
Minus
<
FIRST PRESENTATION OF MULTIPLE DEPENDENT CLAIM □
SMALL ENTITY OTHER THAN
TYPE I 1 OR SMALL ENTITY
I RATE
FEE
RATE
FEE
BASIC FEE
370.00
OR
BASIC FEE
740.00 1
X$9=
OR
X$18=
X42=
OR
X84=
+140=
OR
+280=
TOTAL
OR
TOTAL
OTHER THAN
SMALL ENTITY OR SMALL ENTITY
RATE
ADDI-
TIONAL
FEE
RATE
ADDI- |
tionalI
FEE 1
X$ 9=
OR
X$18=
X42=
OR
X84=
+140=
OR
+280=
TOTAL
ADDIT. FEE
OR
TOTAL
ADDIT. FEE
* If the entry in column 1 is less than the entry in column 2, write "0" in column 3.
** If the "Highest Number Previously Paid For" IN THIS SPACE is less than 20, enter "20."
***lf the "Highest Number Previously Paid For" IN THIS SPACE is less than 3, enter "3."
The "Highest Number Previously Paid For" (Total or Independent) is the highest number
RATE
ADDI-
TIONAL
FEE
X$9=
X42=
+140=
TOTAL
ADDIT. FEE
RATE
ADDI-
TIONAL
FEE
X$ 9=
X42=
+140=
TOTAL
ADDIT. FEE
OR
OR
OR
OR
RATE
X$18=
X84=
+280=
TOTAL
ADDIT. FEE
ADDI-
TIONAL!
FEE
OR
OR
OR
OR
RATE
X$18=
X84=
+280=
TOTAL
ADDIT. FEE
ADDI-
TIONAL |
FEE
found in the appropriate box in column 1 .
FORMPTO-875 (Rev. 8/01)
Patent and Trademark Office. U.S. DEPARTMENT OF COMMERCE
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